This article is intended to help inform patients, relatives of patients and health professionals. The information in the grey boxes is more technical and intended more for Health professionals that are reading this article.

 

What are Adenoids?

Adenoids are small glands located in the back of the nose. They play a role in our body’s immune system which provides defence against infection. They tend to shrink with age so typically only cause issues in children or young adults

Adenoids, Adenoiditis, and adenoid hypertrophy (enlarged adenoids)

The adenoids can cause problems when they become inflamed, this being called “adenoiditis”. They can also become large, blocking the nose.

Large Adenoids

Adenoids, Adenoiditis, and adenoid hypertrophy (enlarged adenoids)

 

Causes

Adenoiditis is often caused by an infection. Common germs that cause infection are viruses and less commonly bacteria. Other things that may cause adenoiditis include allergy to particles in the air that we breathe (such as pollen) or acid reflux from the stomach (heartburn).

 

Clinical Features/Symptoms/Signs

People who have adenoiditis may have one or more of the following symptoms:
– Cough
– Runny nose (yellow or green)
– Bad breath
– Blocked nose (which may lead to snoring – particularly if the adenoids are large)
– Mucus running in the back of the throat (post-nasal drip)

 

Diagnosis:

Your doctor will usually rely on history and physical examination to make the diagnosis of adenoiditis. You cannot easily see the adenoids through the nose or mouth but your doctor may use a mirror or a small flexible camera (endoscope) to see the adenoids.

If your doctor is worried about bacterial infection they may decide to take a sample of the fluid in the nose or throat. Some assessment of the size of the adenoids can also be done using X-ray.

 

Complications:

Persistent or recurrent adenoiditis can cause adenoids to become large. This could result in mouth breathing as the nose may be blocked. This could lead to snoring and in severe cases obstructive sleep apnoea (recurrent short periods of partial or complete blockage of breathing during sleep).

Obstructive sleep apnoea is the most serious complication of large adenoids. This can cause disturbed sleep which is not restful and may lead to learning and behaviour problems.

Long-standing mouth breathing can also lead to changes in the way that the teeth and bones in the face grow and develop. Adenoiditis can also play a role in recurrent ear infections.

 

Treatment/Management

Your doctor will decide on the best course of action after consultation with you. There are a number of options:

– Watch and wait: If adenoiditis is caused by a common cold or other common viral infection, your doctor may decide on watch and wait management. Especially if this not a recurrent problem. Typically, adenoiditis will resolve within a week.

– Medical management: If your doctor is worried about infection, they may prescribe antibiotics (e.g. Penicillin) to use. In case of presumed large adenoids with no signs of infection, your doctor may consider a trial of nasal steroid spray.

If your doctor believes the cause of symptoms is allergy, then your doctor may trial steroid nasal spray or antihistamines. In addition, allergy testing may be considered.

If acid reflux (heartburn) is thought to be contributing, then your doctor may offer lifestyle and diet advice. There are also medications that can help.

– Surgical management: If symptoms don’t get better, despite medical management, your doctor may refer you to an ENT surgeon. They may discuss the option of surgical removal of adenoids (Adenoidectomy) with you. Patients with adenoid problems often also suffer from middle ear problems or tonsil problems. In these situations, your doctor may also discuss grommets or tonsillectomy at the same time.

 

Prevention

Adenoiditis is a common problem in children and difficult to prevent. Children are frequently in contact with viruses and bacteria that cause adenoiditis. They are also frequently exposed to elements in the environment that they may be allergic to.

In case of recurrent or persistent adenoiditis seeking medical advice may help prevent large adenoids and its complications such as obstructive sleep apnoea.

 

Prognosis

In most cases watch and wait or medical management is sufficient. For those who have recurrent or persistent adenoiditis or large adenoids, then surgical removal of the adenoids (adenoidectomy) typically provides a long lasting solution.

 

Impact on daily life

In children with an episode of adenoiditis, usually they experience a blocked and runny nose, and may experience some snoring at night. These will improve once they have recovered which is usually within a week.

In a case of persistent or recurrent adenoiditis, particularly when the adenoids have become large, children may have persistent blocked and runny nose, mouth breathing, and problem with breathing during their sleep include obstructive sleep apnoea.

 

Further reading:

https://emedicine.medscape.com/article/872216

 

References:
1. Pasha R, Golub J S. Otolaryngology Head & Neck Surgery, Clinical reference guide, Plural publishing. 4th edition. 2013.
2. Bowers I, Shermetaro C. Adenoiditis. [Updated 2020 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536931/

 

Author + Affiliation:
Dr Omid Ahmadi – ENT registrar, Waikato Hospital

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Adenoids, Adenoiditis, and adenoid hypertrophy (enlarged adenoids)

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